Search

Aim:In this retrospective study, our objective was to evaluate children with arterial or venous thromboembolism, who were treated with tissue plasminogen activator (tPA) in our hospital.Materials and Methods:The medical records of 56 tPA treatments administered to 53 patients with thrombosis in the paediatric intensive care unit and paediatric clinic at Çukurova University, Balcalı Hospital between September 2013 and August 2018, were investigated retrospectively.Results:Thirty-three of the patients were males (58.9%). The median age was 13.5 months (0-203 months). Fifty-two of the patients received low-dose tPA treatment (91.2%) and the mean treatment duration was 63.8±43.3 hours (3-192 hours). Thrombolytic treatment was administered to 38 patients (67.8%) with catheter-related arterial thrombus, to 8 patients (14.3%) with intracardiac thrombus, to 4 patients (7.2%) with pulmonary arterial thrombus, and to 6 patients (10.7%) with deep venous thrombus. No complication was observed in 47 treatments (83.9%). However, 7 patients had minor (12.5%) and 2 patients had major bleeding (3.6%). Recanalization could not be achieved in 8 cases (14.3%) and 4 patients underwent thrombectomy. The use of anticoagulant treatment with tPA did not change the complication rate or the success rate of the recanalization.Conclusion:We determined that low-dose tPA treatment was effective in the treatment of life-, limb- or organ-threatening arterial and venous thromboembolism in children. However, randomized studies with larger sample sizes and control groups are required.

Introduction:The causes of intoxication can vary from country to country, from region to region within the same country and even in the same region over the years. In this study, the patients with intoxication diagnosis were evaluated in terms of their demographic characteristics, intoxication reasons and also the factors causing intensive care hospitalization in our pediatric intensive care unit (PICU).Methods:The study included 115 patients with intoxication diagnosis between one month and 18 years of age, who were followed up in PICU between January 2017 and December 2019.Results:The median age of the patients was 154 (interquartile range, 37-196) months and 51 patients (44%) were male. The median age of female patients and the patients who were hospitalized due to suicide attempt were higher (p

Purpose: The aim of this study was to evaluate the lung-protective mechanical ventilation strategy, early enteral nutrition, negative fluid balance, and adequacy of hospital resources in our pediatric intensive care unit.Materials and Methods: This study included 32 patients who developed acute respiratory distress syndrome (ARDS) during their monitoring in the pediatric intensive care unit.Results: According to their oxygenation status, 14 patients (43.8%) had mild ARDS, nine patients (28.1%) had moderate ARDS, and nine patients (28.1%) had severe ARDS. High-frequency oscillatory ventilation was applied to three patients (9.3%), and four patients (12.5%) received extracorporeal membrane oxygenation (ECMO) support. The most common complications were nosocomial infection (31.3%) and pneumothorax (12.5%). The mortality rate was 6.3%. The survival rate was 75.0% in patients with ECMO support. The patients with a higher Pediatric Index of Mortality (PIM-2) score confronted more severe ARDS, and non-pulmonary ARDS also progressed in advanced stages.Conclusion: In patients with high PIM-2 and PELOD scores, attention must be given to the development of severe ARDS. The lung-protective mechanical ventilation support, early enteral nutrition, negative fluid balance practices, and the adequacy of hospital resources led to a successful survival rate in our study. However, multicenter randomized controlled trials are needed on this subject., Amaç: Bu çalışmanın amacı akciğer koruyucu mekanik ventilasyon stratejisi, erken enteral beslenme, negatif sıvı dengesi ve hasta kaynaklarının yeterliliğinin akut solunum sıkıntısı sendromu olan çocuklarda sağ kalım üzerine etkisini değerlendirmektir. Gereç ve Yöntem: Çalışmaya çocuk yoğun bakım ünitemizde akut solunum sıkıntısı sendromu gelişen 32 hasta dahil edildi. Bulgular: Oksijenizasyon durumlarına göre 14’ü hafif (% 43.8), 9’u orta (% 28.1) ve 9’u ağır (% 28.1) evre akut solunum sıkıntısı sendromu gelişmiş idi. Üç hastaya (% 9,4) yüksek frekanslı osilasyon ventilasyon, dört (% 12,5) hastaya ekstrakorporeal membran oksjenizasyon desteği sağlandı. En sık görülen komplikasyonlar ventilatör ilişkili pnömoni (% 21.9) ve pnömotoraks (% 12.5) idi. Mortalite oranı % 6.3 idi. Ekstrakorporeal membran oksjenizasyon uygulanan hastalarda sağ kalım oranı %75 idi. Pediatric Index of Mortality-2 skoru yüksek olan ve non-pulmoner kaynaklı akut solunum sıkıntısı sendromu hastaların takibi sırasında gelişebilecek akut solunum sıkıntısı sendromunun şiddetinin daha ağır olduğu görüldü. Sonuç: Akciğer koruyucu mekanik ventilasyon desteği, erken enteral beslenme, negatif sıvı dengesi ve yeterli hastane kaynakları sağkalımı arttırabilir. Ancak, çok merkezli randomize kontrollü çalışmalara ihtiyaç vardır.

Background and aim Point-of-care ultrasound imaging of the inferior vena cava distensibility index is a potential indicator for determining fluid overload and dehydration in the mechanically ventilated patients. Data on inferior vena cava distensibility index and inferior vena cava distensibility variability are limited in mechanically ventilated pediatric patients. That is why our aim in this study was to measure inferior vena cava distensibility index and to obtain mean values in pediatric patients, ventilated in the operating room before the ambulatory surgical procedure started. Materials and methods This crosssectional study was performed between February 2019 and February 2020. Ultrasonographic measurements were performed in a total of 125 children. Results In a period of 13 months, the measurements were performed in a total of 125 children, of which 120 (62.5% male) met the criteria and were included in the study. Overall inferior vena cava distensibility index (%): mean ± SD: 6.8 ± 4.0, median (min–max): 5.7 (1.4–19.6), IQR: 3.8–8.7. Overall inferior vena cava distensibility variability (%): mean ± SD: 6.5 ± 3.7, median (min–max): 5.5 (1.4–17.8), IQR: 3.7–8.4. Conclusion Our study is the largest series of children in the literature in which inferior vena cava distensibility index measurements were investigated.

Purpose: Incidence of diabetes during pregnancy is increasing worldwide, and intrauterine hyperglycemia exposure may have long-term adverse effects on the cardiovascular health of children. We investigated risk of atherosclerosis and carotid intima-media thickness (CIMT) in infants born macrosomic and in infants of diabetic mothers (IDM) at the age of 8–9 years.Method: 49 infants of diabetic mothers (IDM group) and 13 macrosomic infants (Macrosomic group) were included in the study. They were compared with 26 age-matched healthy children with birth weight appropriate for gestational age born to non-diabetic mothers (Control group). Anthropometric measurements, atherosclerosis risk factors and CIMT measurements were performed. Results: There was no significant difference between the groups in terms of age, gender, actual anthropometric measurements, blood pressure measurements, laboratory parameters or atherosclerosis risk factors. Gestational age was lower in the IDM group (pConclusion, CIMT values were higher in IDM and Macrosomic groups. This indicates intrauterine exposure in both groups. Breastfeeding seems very important for IDMs.

Introduction:Providing support for early enteral nutrition reduces the severity and complications of the disease, shortening the length of stay in the intensive care unit and affecting the patients positively. Although there is not enough evidence about when to start feeding in intensive care patients, it is recommended to start feeding within 24-48 hours with hemodynamically stable condition. Conditions such as surgery, sepsis and trauma increase the energy needs of patients. The aim of this study was to determine the first enteral nutrition time of patients with trauma followed up in the pediatric intensive care unit.Methods:The cases followed up between July 2018 and June 2019 in our pediatric intensive care unit due to trauma were examined. The demographic, clinic findings and first enteral nutrition hours of the patient were recorded retrospectively. Intensive care and hospitalization times, trauma mechanisms and affected organ systems were evaluated with intensive care and trauma scores.Results:A total of 49 patients with trauma were included in the study. The ages of the patients were minimum 6 months and maximum 17 years. Thirty eight (77.6%) of the patients were male. There were 31 patients (63.2%) fed within the first 24 hours of admission to intensive care unit and 14 (28.6%) patients fed within 24-48 hours, and the number of patients with an initial enteral nutrition time over 48 hours was 4 (8.2%). The reason for not being fed within the first 48 hours was the requirement of an abdominal surgery after trauma. The length of hospital stay of those who started feeding within the first 24 hours was shorter (p=0.009).Conclusion:It is of importance to provide nutritional support in critically ill children with trauma in the intensive care unit, as in other patient groups. If there is no contraindication in terms of nutrition, patients should be fed as early as possible, the enteral route should be preferred, and the sufficiency of the calories given should be frequently evaluated.

Airway secretions may increase in intubated patients due to the impaired mucociliary clearance, impaired cough reflex, abnormal glottic function, insufficient moisturizing, and respiratory tract infections. As with any intervention, patients should be cautiously monitored for possible complications during the endotracheal suctioning. Procedure-related changes in the cerebral and somatic tissue oxygenation, hemodynamics, and oxygen saturation can be observed in these patients. It is important to ensure maintenance of tissue oxygenation during these and other interventions performed in critically ill children. The aim of this study was to investigate the effects of the endotracheal suctioning on tissue oxygenation in patients undergoing mechanical ventilation in the pediatric intensive care unit. Cerebral and somatic near-infrared spectroscopy (NIRS) monitoring were performed noninvasively using standardized NIRS equipment as a means of monitoring regional tissue oxygenation. Vital signs, level of sedation, pain scores, and somatic and cerebral tissue oxygenation values of mechanically ventilated patients were recorded prospectively 5 minutes before, during, and after endotracheal suctioning. Cerebral NIRS measurements did not exhibit any statistically significant changes during endotracheal suctioning. Somatic NIRS levels changed significantly before, during, and after endotracheal suctioning and remained low throughout the procedure. Endotracheal suctioning is an invasive intervention that facilitates clearance of tracheal secretions and maintenance of the oxygenation and ventilation. The maintenance of the tissue oxygenation should be documented during these and other interventions performed on critically ill children. Somatic NIRS is a useful tool for monitoring tissue oxygenation during such procedures.

Background The number of studies evaluating delirium and its frequency in critically ill infants, children, and adolescents is increasing day by day. The primary objective of this study was to evaluate all patients hospitalized in our pediatric intensive care unit (PICU) in terms of pediatric delirium, to determine the frequency and risk factors of pediatric delirium. Patients and methods The patients included in this study had been hospitalized in the PICU between November 1, 2018, and August 31, 2019, and were followed up for more than 48 hours. Results Delirium was detected in 14 patients (9.9%) through regular evaluations. The Pediatric Index of Mortality 2 (PIM2) scores and the length of stay in the PICU were higher in patients with delirium (p = 0.03 and p = 0.01, respectively). The use of respiratory support, sedation-analgesia, vasoactive and corticosteroid treatments, and physical restraints were higher in patients with delirium and were statistically significant (p

This study was aimed to evaluate the success rate of high-flow nasal cannula (HFNC) oxygen therapy and factors causing therapy failure. This prospective observational study included 131 children who received HFNC oxygen and followed-up in the pediatric emergency department, pediatric clinics, and pediatric intensive care unit between March 2018 and December 2019. The median age was 23.0 months (interquartile range [IQR]: 9.0–92.0) and 65 patients were male (49.6%). The most common reason for requiring HFNC oxygen therapy was pneumonia (n = 75, 57.3%). A complex chronic condition was present in 112 (85.5%) patients. Therapy success was achieved in 116 patients (88.5%). The reason for requiring treatment and the patients' complex chronic condition did not affect the success of the therapy (p = 0.294 and 0.091, respectively). In the first 24 hours of treatment, a significant improvement in pulse rate, respiratory rate, pH, and lactate level were observed in successful HFNC oxygen patients (p

The aim of this study was to evaluate the Candida species, predisposing factors, antifungal treatment approaches, and clinical outcomes of invasive Candida infections (ICIs) in a tertiary pediatric intensive care unit (PICU). A retrospective study was performed from January 2008 to January 2019 including 102 children with ICIs who were admitted to a university hospital in southeastern Turkey. Positive blood cultures were detected in 43 (42.1%) patients, and positive urine cultures were detected in 59 (57.8%). According to our results, Candida albicans (42.2%) was the most common species for all isolates followed by C. parapsilosis (17.6%). In our patient population, non-albicans Candida species were dominant (57.8%) in all isolates. The most common facilitating factor in our study was the use of mechanical ventilator support (87.3%). The mortality rate of our patients with ICIs was 13.7%. Candida albicans was found to have the highest mortality rate among all Candida species (30.7%). When we compared patients with C. albicans and those with non-albicans Candida species in terms of risk factors, we detected a significant difference between the two groups for total parenteral nutrition use (p = 0.027). Fluconazole was the most preferred (58.8%) treatment option in our PICU for ICIs. Our results showed an increased trend in micafungin use in recent years. ICIs are a significant problem due to the high mortality and morbidity rates in critically ill pediatric patients in PICUs. In recent years, an increase in Candida infections caused by non-albicans Candida species has been reported. Multicenter prospective studies are needed to determine the risk factors for ICIs.

BACKGROUND Measurement of the optic nerve sheath diameter (ONSD) with point-of-care ultrasound (POCUS) is a non-invasive and radiation-free technique that can be used to assess increased intracranial pressure (ICP). Ophthalmic artery and central retinal artery Doppler indices can be used like transcranial Doppler to evaluate increased ICP. This study aims to examine the diagnostic value of ONSD measurements and central retinal artery Doppler indices in the evaluation of pediatric patients with increased ICP. METHODS This was a prospective, case-controlled single center study. The study group was comprised of a total of 38 pediatric patients with increased ICP and the control group included 19 healthy children. Ophthalmic ultrasound was performed and ONSD and central retinal artery Doppler indices were measured. RESULTS The mean age of the study group was 80.84 ± 65.12 months. The mean ONSD was 5.9 ± 0.8 (3.6-8.1) mm in the study group and the mean resistive index (RI) was 0.71 ± 0.08 (min:0,55-max:1) and was significantly greater than the control group (p < 0.001 and p < 0.001, respectively). In terms of predicting increased ICP, the ONSD measurement was the strongest parameter, with its area under the curve: 0.767 (95 percent confidence interval: 0.68-0.85). In the study group, the cut-off value for ONSD was 5.8 mm (66 percent sensitivity, 100 percent specificity) and the cut-off value for RI was 0.68 (63 percent sensitivity, 83 percent specificity). CONCLUSIONS Point-of-care ultrasound is a noninvasive and important tool in pediatric intensive care units. Our study is significant as one of the few pediatric studies where central retinal artery Doppler indices are evaluated in addition to OSND, in patients with increased ICP.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, an autoimmune neurological disorder resultant from the autoantibodies directed to the NR1 subunit of the NMDAR, is mainly characterized by neuropsychiatric symptoms, including behavior changes, paranoia, delusions, epileptic seizures, movement disorders, aphasia, insomnia, dysautonomia, and altered consciousness. Pulmonary embolism (PE) presents with pleuritic chest pain, hemoptysis, and respiratory distress by obstruction of the pulmonary circulation. Unlike adults, pediatric PE usually related to obvious risk factors, including central venous line, malignancy, lupus erythematosus, renal disease, congenital thrombophilia, surgery, and major trauma. Besides, PE has rarely been encountered in adult patients with anti-NMDAR encephalitis even in the absence of these risk factors.A 16-year-old male patient, with acute psychosis, epileptic seizure, and altered consciousness, was diagnosed as having anti-NMDAR encephalitis and treated by intravenous immunoglobulin and high-dose pulse intravenous methylprednisolone. During follow-up, on the 11Pulmonary embolism should be kept in mind as a possible cause of respiratory insufficiency in pediatric anti-NMDAR encephalitis patients along with altered consciousness, breathing instability, hypersalivation, status epilepticus or dystonia, and their treatment.

Objective There is no clear consensus regarding the definition of low cardiac output syndrome (LCOS) or the follow-up of this patient group. Given this lack of a clinical definition, the aim of this study was to use a LCOS score (LCOSs) similar to the low cardiac output score previously presented in the literature and evaluate the relationship between a high LCOSs and poor clinical outcome. Methods A total of 54 patients were prospectively evaluated after cardiac surgery. The LCOSs was used to evaluate the deve-lopment of low cardiac output. Each parameter was scored as 1 point. The score was calculated every hour for 24 hours postoperatively and the highest score was recorded as the peak score (pLOCSs). The LOCSs at the time of admission to the pediatric intensive care unit, at the 4th, 8th, and 16th hour were recorded and a cumulative score (cLOCSs) score was calculated. Results The mean age of the patients was 49.40±53.15 months and 24.07% had LOCS. In the group with LCOS, the cLOCSs, vasoactive-inotropic score (VIS), lactate mean, aortic clamp time, and the total cardiopulmonary bypass time were significantly higher. In this study, a significant and positive correlation was found between the cLOCSs and pLOCSs and the length of hospital stay, length of stay in the pediatric intensive care unit, VIS, lactate mean, and aortic clamp duration. Conclusion The objective of this study was to draw attention to the potential use of a common language in the care of critical pediatric patients undergoing cardiac surgery with a previously defined scoring method that includes parameters indicating poor perfusion in the patient.

Metformin is an oral antidiabetic medication which belongs to the class biguanide. Its most hazardous and life-threatening side effect is lactic acidosis which has been increasingly reported in recent years. Early diagnosis and aggressive treatment approaches have significantly reduced morbidity and mortality rates in metformin intoxication. In this case report, we emphasize the importance of early continuous renal replacement therapy in metformin-associated lactic acidosis in a 16-year-old patient who developed severe renal damage during the follow-up period of renal replacement therapy due to lactic acidosis after taking metformin in a suicide attempt.

The aim of this study was to evaluate the Candida species, predisposing factors, antifungal treatment approaches, and clinical outcomes of invasive Candida infections (ICIs) in a tertiary pediatric intensive care unit (PICU). A retrospective study was performed from January 2008 to January 2019 including 102 children with ICIs who were admitted to a university hospital in southeastern Turkey. Positive blood cultures were detected in 43 (42.1%) patients, and positive urine cultures were detected in 59 (57.8%). According to our results, Candida albicans (42.2%) was the most common species for all isolates followed by C. parapsilosis (17.6%). In our patient population, non- albicans Candida species were dominant (57.8%) in all isolates. The most common facilitating factor in our study was the use of mechanical ventilator support (87.3%). The mortality rate of our patients with ICIs was 13.7%. Candida albicans was found to have the highest mortality rate among all Candida species (30.7%). When we compared patients with C. albicans and those with non- albicans Candida species in terms of risk factors, we detected a significant difference between the two groups for total parenteral nutrition use ( p = 0.027). Fluconazole was the most preferred (58.8%) treatment option in our PICU for ICIs. Our results showed an increased trend in micafungin use in recent years. ICIs are a significant problem due to the high mortality and morbidity rates in critically ill pediatric patients in PICUs. In recent years, an increase in Candida infections caused by non- albicans Candida species has been reported. Multicenter prospective studies are needed to determine the risk factors for ICIs.

Aim Foreign body aspiration is one of the common home accidents that requires urgent diagnosis and treatment, especially in children aged between 1 and 3 years. The type, location, and obstruction level of the aspirated material, age of the patient, and time of diagnosis influence the severity of the clinical picture. In our study, we aimed to evaluate patients who underwent bronchoscopy in our clinic with a diagnosis of foreign body aspiration in light of literature data. Material and methods The medical records of 87 patients who underwent rigid bronchoscopy with a prediagnosis of foreign body aspiration in Cukurova University, Faculty of Medicine, between January 2016 and August 2018, and were followed up in the pediatric intensive care unit after the procedure were examined retrospectively. The subjects were evaluated in terms of age, sex, primary referal center, time of presentation, symptoms at presentation, physical examination findings, radiologic investigations, type and location of foreign body, and duration of stay in the intensive care unit. Results A total of 87 patients were included in the study. Thirty-seven patients (42.5%) were female. The mean age was found as 33.73±39.44 (range, 5-202) months. The most common (74.7%) symptom at presentation was sudden onset of coughing. The foreign body aspirated was organic in 62.1% of patients. The most common foreign bodies aspirated were peanuts, with a rate of 19.5%. Four adolescent female patients underwent broncoscopy because they aspirated needles they held in their mouths while tying their headscarves. Interestingly, one patient aspirated a stone and one patient aspirated a parasite. The most frequent location of foreign body was the right main bronchus (n=27, 31%). Conclusion In the diagnosis of foreign body aspiration, the most important step is maintaining a high index of suspicion. Foreign body aspiration should be considered in patients who present with cough, respiratory distress or cyanosis, unilaterally diminished breath sounds, ronchi or stridor on physical examination, and air trapping on chest X-ray. Bronchoscopy is life-saving in the presence of any suspicious history suggestive foreign body aspiration or refractory pneumonia, even if a physical examination and radiologic findings are normal, especially in high-risk children between 1-3 years old.

Background: Scorpion stings are common in countries dominated by rural and coastal settlements with temperate climate. Scorpion stings are usually harmless and can be seen in local findings, but in some cases, systemic, neurotoxic, and cardiotoxic findings can be seen. Case report: A 3 year 7 month old girl was referred to pediatric emergency care 2 h after yellow scorpion (species of Leiurus abdullahbayrami) sting. In our case, cardiac function insufficiently progressed in spite of the standard inotropic and milrinone treatment. On the third day of hospitalization, levosimendan was initiated with good clinical effect. Conclusion: In the literature, the use of levosimendan in pediatric patients has been limited to those with low cardiac output syndrome after cardiovascular surgery. The use of levosimendan in children with scorpion sting has been previously reported only in Banille et al.’s study. Scorpion antivenom should be administered intravenously as soon as possible in cases of systemic findings that develop after scorpion stings. This report suggests that levosimendan is temporally associated with improvement in patients who have severe cardiac dysfunction due to scorpion sting and refractory to current treatment.

Answer 1: Brown tumor: Brown tumors are rare focal giant cell lesions of the bone caused by hyperparathyroidism (HPT). Although brown tumors can present at different locations and with unexpected clinical manifestations, common areas of involvement are the mandible, sternum, pelvis, ribs and femur. It is a lytic but benign bone tumor, commonly present in patients with secondary HPT due to chronic kidney disease (CKD), mainly in those with untreated renal osteodystrophy (ROD).

PubMedID: 27072279 [No abstract available]

PubMedID: 25966785 [No abstract available]